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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 7_/3 7 -------------------- - ---- pTriplicate) Permit No. ---------- ---------- - ------- ---"---- (Complete in - --------------- --------- - ----------------- Date Issued. lc '-7 7 ;1 This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and,install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations ---- - ------------ CENSUS TRACT JOB ADDRESS/LOCATION..24'06---------Q-° -- - f, Owner's Name---- /i°A1 � --- /- -$ Fl�. _ - 7-0 ,/� Address_..-----�' /� -------- ' +', =- 4------ ----------- City J'=/C' 7� :Phone= Contractor's Name_.U" ------------ License �- -- Installation will serve: Residence /Apartment House Comrrlerc+a-1 ❑ Trailer Court ❑' x 4. Motel Other --------- Number of living units------------------Number of bedrooms._-As.--Garbage Grinder.--------- Size------- _- ------- ---_---= ;_ � �- ------------Private Water Supply: Public System and name--------------------------------- -------.- . Y 1 Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay © Peat ❑V Sandy Loam [I Clay Loam i ," Hardpan F] Adobe ❑ Fill Material_______..-_If yes,type__---- --------------------- r (Plot plan, showing size of lot, location of system in relati n to wells, buildings, etc.inust be placed on reverse side.) NEW INSTALLATION: (No-septic tank or seepage ;pit.permitted if public sewer i€ avail ble within 200 feet,) fI r" Size. PACKAGE TREATMENT SEPTIC TANK -? _ ----Liquid Depth._-6� ------------- ?\ACapacity-[ ] [�]� �7 r pP t YpM.` - Compartments___._.2%------------------------- I Distancetonearest: Well-f_ Q_r'-_ -r--- ---Found afaon._'.�v- --------====Prop. Line__-------------------- - Le_n -' �-�---------Total Length. <--�o------------------- LEACHING LINE: )!.} No. of Lines.,,_____.""- th afeacfi fine._--- - M—A er. a' terial- --I-------- D' Box_y.___TYpa Filter Material /___ _ Z- e th Filt _ Distanceto nearest: lIt Well____-- ---f . Property roperty L"ine_. _ -(---------------------- Foundation - _ = 4e�Fyumber ---- RockFilled Yes ©�No ❑ \SEEPAGE PIT Dept .______.Diameter.____.__._ f - � ex. Table Depth ------�� '-: - --- -.Rock Size----- �� - ------- --------- - -- - --'` 1 . r Foundation ---- ------ --�"-----.Prop. Line--- ------------- i Distance to nearest: Well--'e. (Prev. Sanitation Permit#._"-----"-------------t-------- - ------Date-_`-�-- =-- --=---_.�" ------ 1�f .' -------------------- --- Septic Tank (Specify Requirements)_ ------ = _ 1 s .. . + 1f. -------------- a, '�-I ---,--•_<"'`•" - ------ •-------- - �------- ------------------ ------------------- DislSosal Field (Specify Requirements)-------------- -- -" ----- ---- .----- -- _- - i..1 _�_ _ J {{ t .__---_ -I ___________________ _______ (Draw existing and required addition'on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations oF_the San Joaquir' Local Health District. Home owner or licensed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, l shall not employ any person in such manner as to become .subject a. Workman's Compensation laws of California." ' Signed-.--------- �-- - - - - -------Owner ' T tl /�Ltl� BY------ (if other than'owner) f FOR DEPARTMENT USE ONLY ` " ` l APPLICATION ACCEPTED BY_____�r- - .. -- --- - ----------------DATE -- �679 ------------------------- DIVISION OF LAND NUMBER ------- =------- - ----------------------------------------- DATE-- --------- ----------- ------------------------ DIVISION --------------- ------ ` ---------------- ----------------------- -- ADDITIONALCOMMENTS----------- ---------=-------------------------------------- -- -------------------------------------------------------- ------ ------------ ---=----------------------- -------------------------------- ---- ---------------------------------- ------------- - ----------------- ------------------------------------------------------ ----- ----------------z� � -------------------------------------------------- n Final Inspection-by:------- --- - ----- - -- -----Dater----- ---1� J EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT t F&S ;Z7